This document outlines protocols for outpatient therapeutic programs (OTP) for treating severe acute malnutrition without medical complications. The OTP allows children to be treated at home through weekly or biweekly visits. Children are provided ready-to-use therapeutic food (RUTF) and medications. During visits, children receive anthropometric measurements, medical exams, appetite tests, RUTF rations, supplements, and health education. The goal is to cure malnutrition and prevent medical complications that could require inpatient care.
WHO and UNICEF recommended management of Childhood Diarrhoea.
HLFPPT has been implementing Childhood Diarrhea management programmes with UNICEF and Micronutrient Initiative.
WHO and UNICEF recommended management of Childhood Diarrhoea.
HLFPPT has been implementing Childhood Diarrhea management programmes with UNICEF and Micronutrient Initiative.
Checking for Immunization, Folic acid and Vitamin A statusAnkit Dama
IMNCI described method for assessing immunization, folic acid and vitamin A supplementation status of children from 0 to 2 months and 2 months to 5 years of age group.
Checking for Immunization, Folic acid and Vitamin A statusAnkit Dama
IMNCI described method for assessing immunization, folic acid and vitamin A supplementation status of children from 0 to 2 months and 2 months to 5 years of age group.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
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Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
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Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
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Off-target Effects: Unintended DNA edits can have unforeseen consequences.
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International Collaboration: Clear guidelines are needed for research and human trials.
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R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
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Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
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CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
3. *Complications anorexia or no appetite, intractable vomiting, convulsions,
lethargy or not alert, unconsciousness, lower respiratory tract infection
(LRTI), high fever, severe dehydration, severe anaemia, hypoglycaemia, or
hypothermia
**Children with MAM with medical complications are admitted to
supplementary feeding but are referred for treatment of the medical
Acute
Malnutrition
Severe Acute Malnutrition
With Medical
Complications*
Inpatient Care
Severe Acute Malnutrition
Without Medical
Complications
Outpatient
care
Moderate Acute Malnutrition
Without Medical
Complications**
Supplementary
Feeding
4. The Outpatient Therapeutic Programme (OTP)
is treatment at home for children with severe
acute malnutrition with appetite and without
medical complications.
The majority (about 85%) of SAM children can
be treated at home without the need for
referral to inpatient care.
Visit every week or two week
5. Category Criteria (any of the following)
Children 6-59 months MUAC < 11.5 cm (115mm) OR
Bilateral pitting oedema grade + or ++
AND Appetite, clinically well and alert
Mother/caretaker refuses inpatient care
despite advice
Other reasons for enrolment in OTPasons for OTP enrolment
Transfer from inpatient care Child returns to OTP after transfer to in-patient
care Or other OTP site after treatment
or is referred to OTP after inpatient care or from
another OTP site
Return after default Children who return after default continue their
treatment if they still fulfill the enrolment criteria
for OTP
6. Category Criteria
Cured
MUAC >115mm
Clinically well
And
15% weight gain
And
No oedema for two consecutive visits (if admitted
with oedema)
Defaulted Absent for 3 consecutive visits (OTP is every week)
Absent for 2 consecutive visits (OTP is every two
weeks)
Died Died during time registered in OTP
Not recovered* Has not reached exit criteria within 4 months.
7. Registration / Follow-up record
Anthropometrics
Physical examination
Sugar Water
Appetite Test
Routine Medicines
RUTF Ration
Supplemental medicines if required
Health Education
8. Identify and treat urgent cases first
Offer water on arrival to all cases. Sugar water
(10% sugar) should be given if sugar is
available.
(Two teaspoons of sugar / 100ml of water or
20 teaspoons in 1 litre of water)
10. Medical and dietary history
Physical examination
Use the Action Protocol (Page 78 of CMAM
guidelines) to determine if there are any
medical complications
◦ If the child has one or more medical complications
transfer the child to inpatient care
◦ If the child has no medical complications give an
appetite test
11. Appetite must be assessed to see if the
child will eat the RUTF necessary for
recovery
Appetite Observation Action
Good Child takes the RUTF
eagerly
Child may continue in
OTP
Poor Child takes RUTF with
persistent
encouragement
Child may continue in
OTP but must be
observed carefully for
any weight
loss or clinical
deterioration
Refused Child refuses RUTF even
after persistent
encouragement
Transfer to inpatient
care
12. Decide if the child should continue in OTP or
be transferred to inpatient care
◦ If the child refuses to eat RUTF or has any medical
complications he/she should be referred to
inpatient
◦ Infants less than 6 months who meet the criteria
(visibly wasted, have oedema or are too feeble to
suckle effectively)
13. Register
RUTF according to weight
Medicines
Immunization
Continue breastfeeding
RUTF key messages
Date and time of next visit
14. 14
Drug W hen Age/W eight Prescription Dose
6 monthsto < 1 year 100 000 IU
≥ 1 year 200 000 IU
Syrup 125 mg
5ml
Syrup 125mg
10ml
On enrolment
(asrequired)
< 1 year DO NOT GIVE None
12-23 months 250 mg
≥ 2 years 500 mg
**ANTI-MALARIAL: Give if child has fever for more than 48 hours and other cause of fever is absent AND child lives in
high malarial area
*** ALBENDAZOLE: Albendazole may be used instead of Mebendazole: < 1 year: DO NOT GIVE; 12-23 months:
200mg; ≥2 years 400mg
IRON/FOLIC ACID ***
On day 14 for
mild/moderate
anaemia > 2 monthsold
See iron/folic
acid protocol
Give one dose daily for
14 days
* VITAMIN A: Do not give, if the child has already received Vitamin A in the last one month.
MEBENDAZOLE*** Second visit Single dose on second
visit
MEASLES
VACCINATION
On week 4
From 6 months Standard Once on week 4
12months-5 years(10-
19kg)
ANTI MALARIAL**
>2 monthsold
See malaria
protocol See malaria protocol
VITAMIN A* On enrolment
Single dose on
enrolment.
AMOXYCILLIN On enrolment
2-12 months(4-10kg)
3 times/day for 5 days
15. RUTF is food and medicine for malnourished
children only. It should not be shared
Sick children often don’t want to eat. Give small
regular meals of RUTF and encourage the child to
eat often (6 times a day is possible)
Your child should have X (note the amount
according to weight of child) amount of RUTF a day
RUTF is the only food your child needs to recover
during the time in OTP
Breastfeed before giving RUTF. Young children
should continue to breast feed regularly
16. Always offer plenty of breast milk or clean water
to drink while eating RUTF. RUTF makes children
thirsty and your child will need to drink more
than normal.
Use soap to wash your child’s hands before
eating if possible.
Keep food clean and covered
When a child has diarrhea, never stop feeding.
Give extra food and extra clean water.
Children with oedema only: Don’t worry if your
child looks thinner at first. This is because
he/she is losing fluid from the body. Continue to
give RUTF.
17. Hand-washing with soap before eating and
after defecation
Exclusive breastfeeding (for 6 months) and
introduction and use of appropriate
complementary foods using locally available
food
Continued feeding during illness
18. Explain to the caretaker
Note the final outcome on the OTP card
Advise the caretaker
◦ High fever
◦ Frequent watery stools with blood or diarrhoea lasting more than 4 days
◦ Difficult or fast breathing
◦ Vomiting
◦ Development of oedema
Counsel the mother/caretaker on good nutrition and continued
breastfeeding for children less than 2 years
How to use any medications that have been given / prescribed
Refer to a Supplementary Feeding Programme (SFP) if available.
